By Deborah Borfitz
July 28, 2020 | Most cancer care providers with Kaiser Permanente in Northern California report high satisfaction with telehealth and would like to “maintain or increase” the rate at which it gets used in lieu of in-person patient visits, according to survey results shared by Elad Neeman, M.D., a hematology and oncology fellow at Kaiser’s San Francisco Medical Center, at last week’s American Association for Cancer Research virtual meeting on COVID-19 and cancer. Telehealth utilization in medical oncology has significantly increased since the pandemic hit California, he says, while office visits nosedived from 60.3% of encounters in February to 2.3% in April before making a slight rise to 5% in May.
Over the same time period, the proportion of telephone visits grew from 39.3% to 86.6% and then decreased to 63.7%. Video visits, representing a mere 0.42% of encounters in February—accounted for nearly a third of all visits two months later, Neeman says. In early March, a state of emergency was declared in California and, shortly thereafter, a statewide shelter-in-place order was issued.
Across provider types—including medical oncologists, radiation oncologists, oncology navigators, breast surgeons and oncology survivorship—survey respondents were either “very satisfied” or “somewhat satisfied” with telehealth, he says. The electronic questionnaire was sent to 276 providers affiliated with 22 medical centers on April 9 and had a nearly 70% response rate.
The three main personal benefits of telehealth reported among medical and radiation oncologists and the surgeons was working from home, reduced commute and staying on time, Neeman continues. Less notable benefits were shorter visit times, autonomy of practice and flexible hours. The doctors were neutral when it came to reduced clerical burden.
As to perceived benefits for patients, medical oncologists most commonly cited fewer financial burdens and caregiver convenience, says Neeman. Unsurprisingly, all survey respondents thought in-person visits offered a strong provider-patient connection. Most of them felt the same way about video visits, and about half for telephone visits. This was much less the case with email.
Commonly cited challenges were related to connectivity and equipment problems, the need for a physical exam, lack of staff support, and the fact that in-person visits were required anyway, he adds. Of particular concern was that “10.6% of medical oncologists and 8.8% of radiation oncologists perceived an adverse event may have been prevented by an in-person visit,” a finding that Neeman says warrants additional study.
No specific instances of adverse events being missed were cited by the surveyed providers, he says. The provider survey will be complemented with another survey to find out if patients feel anything has “gone wrong” in their diagnosis or treatment because of telehealth, he says.
Interestingly, medical oncologists deemed video visits acceptable for most activities, he says. But many providers still prefer in-person visits for making a new diagnosis (it is “unsatisfying” to have never met a patient in person who expires from their disease, he later notes), palliative care, end-of-life discussions, and clinical trial enrollment. Areas where email or telephone calls were seen as most acceptable were for check-in prior to treatment, survivorship planning and follow-up, and patient navigation.
Surgeons and survivorship providers were the disciplines most likely to want to increase the use of telehealth post-pandemic, says Neeman. The Bay area of California, especially San Francisco, has not had a significantly high rate of COVID-19 infection, he later added. “If we do start to see more of that I think it would just be a reason for us to bolster our telemedicine services even more.”
In addition to oncology visits, supportive services such as physical therapy, nutrition and navigation went into telehealth mode at Kaiser Permanente when the pandemic struck, he says. The diagnostic tools being used remotely include the NCCN Distress Thermometer, physician sharing of visible physical findings during virtual visits, and patient sharing of photos through secure messaging. “We can also share our screen with patients so we can show them relevant findings from studies. We currently do not have the ability to transmit vital signs, but this is something worth exploring.”